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Saturday, September 15, 2012

physician heal thyself *

Six hours into my second day back at work, while on call over Labor Day weekend, this happened.

I thought twice about posting this picture right up at the top, above the fold, but in the end, figured--you know this is a medical-ish blog, right? It's just a little blood, right? YOU CAN HANDLE IT. (You can tell me if I should have thought three times about it instead.)

Anyway, I won't get into too many of the details of how the injury happened--mostly because in the past two weeks I've told this story at work about fifty skrizillion times and am bored of repeating myself--but let's just say that it was obtained while doing a procedure on the general medicine floor, and happened due to a combination of 1.) suboptimal conditions, 2.) poor equipment design, and 3.) poor judgement (my own) in persisting to use said equipment despite #2 in the setting of #1. Be careful with your sharps, everyone. They are...sharp.

Anyway, after finishing the procedure (I luckily had a second set of sterile gloves in my pocket that I was able to put on to finish off the task--a task on a patient that was not at a point where I could walk away) and though the glove was all flabby like a water balloon of blood by the end of the procedure, had a nice tight cuff that contained all my lifeblood quite nicely. Then I irrigated my wound, finished the procedure note, and made haste down to the emergency room, where they took very good care of me.

I was instructed to get my stitches out in ten days, but the problem with wound care on your hand when you work in a hospital is twofold. One, you have to keep your wound pretty covered up at all times--I basically had it laminated with a combination of Steri-strips, Tegaderms, and various configurations of bandages for the entire ten-day course the stitches were in. Secondly, as I think I have mentioned before, I was my hands a lot during the course of an average work day, and no matter how occlusive I tried to make the dressing or how "waterproof" the various products used purported to be, my wound spent the better part of the ten days marinating in a brine of Band-aid water. I tried to take the dressings off when I got home to let the laceration breathe, but the tails and knots of the stitches kept getting snagged on various things (clothing, towels, the kids' faces) so I ended up keeping the bandages on most of the time I was home too--another place where, between food prep and giving baths and changing dipaers--I had to wash my hands almost as often as I did at work.

So when my stitches came out this past Wednesday, the wound looked...rough. First of all, it didn't really look like it had healed at all. It was still gapping significantly, I could still see adipose through the edges of the wound, and the surrounding flesh and skin looked all ragged and macerated. Joe offered to close it for me again, in layers this time with subcuticular stitches, but after mooshing it around and considering, I decided that I would just take off all my bandages whenever I wasn't in the hospital and let the whole thing dry out and close by secondary intention. I was going to take a picture of the wound at this point, but be thankful I didn't, it looked even more gory on Wednesday than it did when I got the injury in the first place. But anyway, it looks like Project Dessicate and Granulate is working, because now, three days after my stitches were removed, my hand looks much, much better than it did a few days ago.

(You'll just have to trust me on that last point.)

* * *

So, I'm back at work! And it is...OK. Actually, it's kind of hard to say how it's been and how it's going to be, since we haven't really officially pressure-tested the system yet. Joe's mom, upon hearing how stressed we were about juggling everything, swooped into town the Tuesday after Labor Day and has been helping out with us at home for the past two weeks--getting dinner on the table, helping Cal with his homework when I'm working late, holding the baby so that Joe or I can go to the bathroom, entertaining-slash-distracting Mack, and any of about a billion different things that tip the balance of our mornings and evenings from smooth to totally unmanageable. The kids have been delighted to have grandma in town, and it's made the transition overall much smoother.

Unfortunately, she has to go home tomorrow. So after that, it's sink or swim. Well, sink, swim or bob, I guess.

Overall, the difficulty with finding our new balance point now that I'm back at work is not so much getting everything done, but deciding if how we're choosing to allocate our time really is the best. Essentially a quality versus quantity argument. Well, let me revise that--it's not quality versus quantity so much as the concern that, with our current setup (three kids, Joe and I both working fairly extensive hours) that we may have neither. Part of the quantity element might be improved in a few months after my call schedule settles out--like I mentioned before, I have a pretty bad schedule for the rest of the year, I assume in part due to the leveling algorithm imposed by the computer system that my practice uses to assign our work assignments. And presumably, the quality of our time might improve when things settle down too--once the newness of the transition wears off, once the kids are more settled into their routines, once the baby gets a little older, etcetera etcetera. Maybe.

In the end, it's all doable, but we'll have to evaluate in another couple of months if the quality of the doing is really the best for everyone. Because I can't help but think--and this is judgement on no one but ourselves--that it feels awfully irresponsible to choose to have three kids and not choose to find some way to spend a little more time with them all.

* * *

You'll have to indulge me this last bit, but Cal's been just exploding with creativity since school started, and just recently, the stuff he's been writing is getting (in my utterly biased opinion) kind of good. He's been saying for a year or so now that he wants to be an author when he grows up, and while until now I've sort of considered it one of those classic Kid Aspirations (teacher, astronaut or similar--interesting to note, however, that Cal has absolutely no interest in becoming a doctor) this is the first time that I've thought there may actually be something to his plan. This (page one of his latest story) has a evocative "Hunger Games" or "Lord of the Rings"-esque feel to it, doesn't it?

(Cal hasn't watched "Lord of the Rings," by the way. When I suggested that he might enjoy it, Joe shot me down saying that it was far too scary for a seven year-old. I don't remember it being particularly terrifying, but what the hell do I know, I slept through the first two movies and didn't even watch the third. What do you think? Is it "Star Wars" level scary, or "Willow" level scary? What is a scary kids movie, anyway? Everyone talks about how magical "E.T." was, but that fucking thing terrified me as a child and still to this day. That neck! Those fingers! THOSE WATERY TREMULOUS EYES.)

Anyhoo. Everyone here's surviving. Even doing well at times. Hope you all are too.

-----
* I am fairly certain that I have used this title for another post before, but I've been keeping this blog for almost twelve years now so I'm fine with some creative reuse if you are.

49 comments:

Wow, what a gnarly wound. I'd be itching to pick at the little scabby bits in the last pic.

On another note, I think I read about The Spirit Catches You and You Fall Down on your blog. The little girl, Lia, has died. http://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?_r=1

Would I be a bad mother if I told you I started watching Lord of the Rings, the extended director's cut with my 4 year old twins? Possible less so since they wandered off in boredom at about the 30min mark.

Cal would adore The Pagemaker (1994); it's about a kid who wants to be an author, and then becomes trapped in the book. Not too scary, and very interesting. Yea to having a grandma in the house those first weeks. Your kids are very lucky.

OMG! That is one ugly wound. It is also one lucky mother-in-law. I'd love an excuse to spend 2 whole weeks with my grandchildren. Cal's story is amazing for his age. I will be in your neck of the woods on the 27th and 28th. Drop by if you are inclined.

ouch. i was going to say it didn't look so... bad.... until i see the subcutaneous fat ("adipose") tissue. must have been pretty deep. but hey, wounds on the palmar surface heal pretty well anyway and you'll probably just have a small faint scar at the end of this (hopefully).

i also had multiple wounds on my hand and fingers (don't ask) a couple of weeks ago and i looked like a crazy idiot trying to stick Tegaderm to cover it up... you should be really experienced by now and know how it gets really cross with a combo of sweat, water and powdered sterile gloves. ewe.

There aren't that many suspenseful moments in LOTR compared to ET. I remember having a four year old panic attack in the theater when Drew Barrymore found ET in the closet (the music, the panning in and out...*shudder*) I think my dad had to take me to the lobby to calm me down. It's more scary when the movie takes place in the "real world" as opposed to some fantasy world - perhaps Cal would be ok with LOTR?

Lord of the Rings def has some scary parts. Gollum basically looks like ET. Then again, i let my kids watch Harry Potter and won't let them watch Bambi or Lady in the Tramp since those traumatized me....

SO many things to comment on - sorry - here comes a novel! Iuughck - cuts, yay for gloves, those suckers sure hold in a lot...and its the part where you have to take it off to see how bad it is, oh boy. Almost exciting, if it wasn't your own hand. Took off the tip of my finger under a glove once, blunt force, felt like a thud. Didn't know until my gloves where sloshing. Lord of The...zzzz.. oh what? Rings. Serious talent -great story, great book- tried SO hard to stay awake. Failed miserably. And it was filmed in my home country! Cal!! That is awesome...so talented! My 6 year old writes stories about killing ...with lots of very anatomically correct pictures! I am torn between keeping them (they are actually rather good.... whilst not being too macabre...) he has a (relatively!) normal life with no great exposure to violence - as much as 6 year old boys discuss these things in-playground and 2nd grade...so if he turns into an superhero-axe-murdering-ray-gun-shooting-laser-zapping-tommy-gun-weilding-flying-bazooka-shooting-(part time military tank driving) psychopath..there will be inked proof splashed about on discovery channel of it starting in childhood!!!?? All my fault! Didn't read the signs! The dilemma! As for quality time with your darlings - every parents stress- it might sound too simplistic but kids grow up super healthy and safe knowing they are loved, not by "knowing mum and dad spent loads of time with me". I don't mean that as a negative, but they are conditioned to latch onto to those who love them, which is usually those who care for them, and if there are a team of these people - all the better!! Go on voted-for holidays together - your kids will always remember those times - but the week in week out stuff, if they get all their needs met they will be so ok...I'm sure others will disagree, and I know you crave your time with your children...those night baby cuddles are to die for.(-: but what do you remember about your childhood? I bet your parents had moments of guilt...as we all do .. but you seem to have turned out ok. You know. Ish. Ha ha (-:Thanks for finding the time to blog, even with a baby asleep on your shoulder...! Good to have you back(-: Hope all flows smoothly over the next wee while x

I always close my wounds with repeating application cyanoacrylate layers whether its deep or not. very satisfying results. - I once cut my forehead accidentally ~1cm long to the bone with my razor sharp hunting knife. I immediately applied pressure to provide hemostasis, until little fibres of fibrine hold the wound lips together. then applied 3 layers of cyanoacrylate, then strips all over the wound. I do not have any serious scar now- visible only from 10cm distance. It happened in july. I've got 4 more months to the final result as wound maturation takes that much. We call it "The JAPANESE GLUE" here in Turkey.

Oh Michelle,I love your blog, I love your family, I have been reading for years and years....why don't you just follow the impulses of your maternal heart, and reduce your hours at work so you can spend more time with your sweet children during these precious formative childhood years? You clearly want to; just dont worry about people might think of you...dont see it as a 'step down'...being a mamma to C, M & N s a unique job that only you, and noone else in the world, can do. They would love it and be so happy too.

I say this as medical doctor myself...I have been on 'maternity leave' for 4 years now. I went back to work after my first child was born, but it just tore my heart to pieces, and he missed me so desperately as well, so I just quit cold-turkey.

I would say follow what your maternal heart is telling you is best for your children......and what is best for them is being with YOU.

Hey Michelle! If your child can write like that at 7 years old, I really think you should encourage it! I sometimes worry about the consume vs create/do ratio in the younger generations but that page gives me hope! Best wishes,J

How lucky for your family that grandma came for an extended visit. What a great opportunity for her and the children to bond more. My own mom-in-law never (may I repeat, never) helped me with my 2 daughters and she lives only 30 minutes away. Now that she's 90 and in subacute rehab, she doesn't have to wonder why I'm not visiting her. Sorry to vent, but I had to let it out. Love your blog, your book, your sewing, all of it. I feel like flying down to Atlanta to help too.

As a mother and child of two workaholics lets me say if your heart is pulling you to be home with your kids and you can swing it financially DO IT! Kids grow so quickly especially when they are babies. All the BS you hear that we all turn out "ok" is BS. My mom stayed home with me for the first nine months and then returned to work full steam ahead. (She was an over zealous teacher taking on all leadership positions while also pursuing a masters of education FULL TIME and did not stop when my brother was born.) I turned out alright (but had SERIOUS BUMPS IN THE ROAD THAT WERE DIRECTLY CAUSED BY BEING CARED FOR BY PEOPLE NOT MY PARENTS) but my brother did not. My parents are married and my father worked the graveyard shift for seven years until my mom made him work a more civilized work schedule. He found his stride with his masters and PhD full time 4.0 all the meanwhile me and my brother were falling apart. (Money was never an issue, just attentive parents and parents who supervise us. We were raised by nannies.) PEople can say what they want but as a mother and child of two working parents who were NOT doctors but worked 80 hours a week each with their combined schedules/commitments.... let me say both of my parents have regrets and dont' have good relationships with either of their kids. My husband is a doctor (Surgeon in training) and we made the conscious choice that I will stay home while he is in training. (I have a college degree and professional work experience). I do lose my mind some times and wish I wasn't stuck in such a provincial city for residency but not a day goes by my daughter doesn't express explicitly: mommy i'm so glad you're home with me. Her words at age 3, not mine. When I want to pull my hair out and wonder why I wasted money/time on the LSAT (I was going to law school when I got pregnant and my husband got sick) I remind myself this is all so fleeting. Who cares what any one thinks of me. Who cares if I'm a SAHM with "help" and whine when my husband works the 36 hour shift and I'm 38 weeks pregnant with the second one and my feet are swollen and I want to cry about it. who cares?!?! I am smart, strong and a wonderful person. No job, salary or degree can make up for these tender moments with my daughter and soon-to-be daughter. Good luck with whatever you decide. You owe no one anything, other than yourself. The best thing about kids (and pets) is that they remind us the importance of living IN THE MOMENT, not living for the next decade. I love your blog by the way. I hope your hand feels better and be grateful GRandma could step in. I'm due in a couple of weeks...my MIL is such an unhelpful painful person we can't have her visit and my mother is so NOT motherly (she can't be up all night with a baby, she hates my dog and if it's not her allergies bothering her she's got ot keep up with her pain meds and sinus meds and drama at work blah blah blah) she's been invited for a "visit" when we're settled-did i mention she lives 6 states away and is all too content to send money rather than share in these "domestic" moments that she will NEVER be able to re-create? Ugh don't get me started. You are blessed and I hope you do find a balance. I love your sewing projects too! Your daughter is ADORABLE.

Hi Michelle, Wow, your hand just about turned my stomach. Thank goodness it seems to be on the mend now.

I love Cal's story and I think we all know that there is something special within that child. I have a 5 year old grandson who is a lot like Helen's son. All he talks about and draws pictures of is killing and fighting and robberies and I am all over my son and dil for it all the time...It is worrisome to me but they tell me most kids play in this manner. Wow, I didn't know that..I kind of have visions like Helen does of one day seeing it spread out all over CNN or something. I hope this is a phase that quickly passes. I miss my sweet baby of even one year ago.

My son and dil have always worked like you and Joe do. Thankfully, we all live close so I have always been there to watch the kids. Our last one, the one who is now 5, did go to pre school the last 2 years. All this talk of killing and fighting makes me wonder just what they taught him, but again, I hope it passes.

I sense something in you, by your words, that wasn't there when Cal and Mack were little. Most likely because of trying to get through residency and then Joe trying to get through the fellowship when Mack was born. You really couldn't have done things much different back then but now I get the feeling you want to stay at home with the kids. I think you should do just exactly whatever makes you feel the best. No one could fault you for wanting to be at home at least for a few years. Even if you went back to work when Nina began Kindergarten if you wanted, I'm sure with your qualifications a job would always be within your reach. I can't imagine having 3 kids all 7 and younger and working full time. My son and dil spread theirs way out and still at times it was quite hard on them. Their oldest is now 22 and the youngest is 5. In between is a 15 year old. 17 years between oldest and youngest is a big spread...You are an awesome woman and mom and I know you will decide what is best for your family whether that means you keep working or not.

Hey, So I discovered your blog this weekend, and kept flipping and scrolling, and reading away since I'm sick. What better way than to spend a weekend in bed than to start following a new blog, right? Not like I should be studying any Organic Chem (pre-med bio major blablaahblah)..........ok I should. But this is much more interesting.

ANYWAY, I found myself on your first post for this blog. It was about you and your husband renting Lord of the Rings for the first time. I just thought that was kinda cool, because here y'all are 9 years later debating on whether or not to let your son watch it! Kinda cool if you ask me!

I'd hesitate with LOTR's scary level-there's nothing inappropriate, but the graphics are amazing. Also, the attention span required is a lot. I introduced my cousin when he was 10 and he loved it then-so perhaps 2 more years?

Was a SAHM when my two boys were infants all the way through till my older son started elementary school. Got lots of flak for "wasting" my medical degree but have not regretted a precious moment of those first several years of bonding & establishing a close relationship with my sons.

Eh, do whatever you want to with your career/homelife, don't let a bunch of Internet strangers make you feel bad about wanting a career and actually liking work. There is value in your children seeing that women don't throw away their careers and stop working because they have children. That being said, I am a medical sub-specialist (cards) who works part-time and it is effing amazing to work parttime! Don't forget it's an option too!!

I too have 3 children. I did the SAHM thing for 6 months and found it too hard of a gig. It was so draining. So I did the next best thing, working as a part-time pediatrician. I love it! Going to work allows me to miss them so that when I come home, it is a lovefest--lots of hugging/kissing/rolling on the floor and enjoying my kids. For me, part-time work allows me the best of both worlds. Life would be perfect if my husband (also a doc) agrees to do part-time too.

I tnink the majority of your readers are of some sort of medicl background or with children. So a little splash of blood should not really gross anyone out.

I thought I remember reading you had a nanny. If not, you need at least one and maybe one and a part-time (on call) one. Seriously with three children and two full-time physicians that include call - you need it more than the rest of us!!!

My kids (7 and 9 yo) love LOTR. It is a new Lego theme. And before I let them watch the movies, I read the whole series to them (still reading, finishing book 2 now). It is written in good english and kids know to wait for the movies, which makes it a neat anticipation. I am actually thinking of purchasing LOTR cartoon, less scary. Still they were not afraid of the movie either. I somehow felt that LOTR series have a bit more of a purpose than modern day horror sequels for kids. There is courage, comaradeship, true friendships, humor and a slew of neat charecters (including live trees). If you are not kin on the movie, you can start with cartoon (it has bright colors unlike dark in the movie). As far as Star Wars, I am thinking to let them watch only the first movie which I like very much myself. The remainder of SW productions just seemed to turn into "clone wars". Lastly, your 7 yo writes like my 9 yo, and spells better too!

Since we're all dropping in a couple pennies worth of "advice" today, thought I might add mine to the mix. I'm a Hospitalist, 4 years out of training, pregnant with my third. My first was born during residency, and ...well... you do what you have to do. My second was born during my second year of full-time practice, while my husband was a full-time student. Again, we just pushed through. I am now settled comfortably into a part-time academic job, working mostly nights, with my days spent shuttling kids around to Kindergarten and preschool, enjoying lunch with my husband, exercising, and having a life. I feel like I'm living the dream right now, keeping up my skills (and making some money) while spending tons of time with my family and (this is key:) myself. I will take a few months off for the third, then plan to go right back to part-time. Will probably return to full-time in a few years, thankfully without much of a hole in my CV.

It seems like Anesthesia and Hospitalist work have similar shift-based schedules. You don't need to be full-time to maintain your skills and... let's face it... you have NOTHING to prove at this point. You are a skilled (if somewhat lacerated) Anesthesiologist, a published author, a nationally-known blogger, a public speaker, a mother of three, now a SEAMSTRESS for gosh-sakes. It's okay to pull back for awhile. You will have a long career: five years of non-full-time work while you and your kids are young is just a blip in time. A lovely well-earned blip.

I hope you find the balance that makes you happy. I feel so privileged to have found it for myself.

Seven? Parents today really coddle their children way more than my drinking/smoking parents of yesteryear. By seven I had seen a few of the Friday the 13th movies, knew all about Freddy Kruger and think I even saw Texas chainsaw (that i still don't understand it's appeal). A little Lord of the Rings is no worse that the star wars flicks

I don't have any advice for you. I just wanted to tell you I've been thinking about you and wondering how you were faring. I know the kids are fine - better than fine, judging by Cal's writing - and I hope you find your balance and groove in managing a family/career/everything. You rock, and you're a good role model for me as I try to balance my own family and career. :) I'm glad you write. Please keep doing it!

Let us all take a moment to grieve the end of a possible hand modeling career (guess you're stuck being a physician now!)...Now, moving on, I am seriously impressed that this is quite possibly the first time that you've ever repeated a blog title. If I chronicled my medicine experience, approximately 9 out of 10 posts probably would have been labeled something like "bitches be crazy." Your extensive use of the american vernacular, as it relates to blog titles, should be applauded. Any nay-sayers should be prosecuted.

As a pediatrician and mother of three (and husband is a pathologist), I have to agree with many of those above recommending cutting down your hours. I just finished 5 years of 0.7 FTE (which, with all the take-home charting involved meant at least 50 hours/week) while my husband was in residency and fellowship. Now that he's working a real job (mostly better hours than training but not always) and we no longer have my mom as our nanny, I'm cutting down to more like 0.45. The 2-year-old will definitely be my last, and I just don't want to have to miss all that like I think I did with my middle girl. She's a really clingy kid, not really confident, and I have to think that my not being there much when she was 1-4 had a lot to do with that.

So on another topic, the clingy now-almost-7-year-old and her 9-year-old sister are both not at all into scary things, but they loved watching Lord of the Rings last year. My husband showed it to them in 15-30 minute segments every few days on his lap, sort of as bedtime story, over a couple of months at times when I needed time to shower or get the littlest guy down to sleep. They were really caught up in the story, and they both identify it as their favorite movie. And the eldest is also an aspiring writer! (We're also just getting into having to think about pushing to skip a school grade with her, as she's not handling the transition from a Montessori elementary school in the city where her dad just did training to the public school (and only real option) in our current small town. . . So needless to say I've really enjoyed reading your blog for all these issues over the last year or so!

Whew. Sorry that was so long. This post was just particularly close to my heart.

I think I still have ET nightmares. And I'm a pediatrician who works part-time- and loves it. I have three kids, like you- a 5 yo boy, a 3 yo boy and a new little girl. However, much as I tell myself my part days are for spendin gtime with them- I really end up doing errands and dragging them to the grocery store :(

Michelle,If your heart is calling you home, cut back your hours ASAP and be there with your perfectly beautiful bunchkins. Then don't look back, because you don't owe it to humanity to "fix" the whole mothers in medicine issue by being the perfect doctor with three kids. Remember that no child ever grows up wishing mommy spent more time at work.

How about Harry Potter? ET was scary...and I think Lord of the Rings was a bit creepy, especially Golium (sp?). Some of the material is a bit dark and it's a bit of a complicated story line, so you should just judge what you feel comfortable/suitable for your child. (But what do I know? I only saw 1 of the three LOR movies and don't have a child...)